At present, the risk of myocardial damage by endurance exercise is under debate because of reports on exercise-associated increases in cardiac biomarkers troponin and B-type natriuretic peptide (BNP); these markers are typically elevated in patients with acute myocardial infarction and chronic heart failure, respectively. Exercise-associated elevations of cardiac biomarkers can be present in elite and in recreational athletes, especially after prolonged and strenuous endurance exercise bouts (e.g., marathon and ultratriathlon). However, in contrast to cardiac patients, it is still unclear if the exercise-associated appearance or increase in cardiac biomarkers in obviously healthy athletes represents clinically significant cardiac insult or is indeed part of the physiological response to endurance exercise. In addition, elevations in cardiac biomarkers in athletes after exercise may generate difficulties for clinicians in terms of differential diagnosis and may result in inappropriate consequences. Therefore, the aim of this article is to provide an overview of exercise-associated alterations of the cardiac biomarkers troponin T and I, ischemia-modified albumin, BNP, and its cleaved inactive fragment N-terminal pro BNP for the athlete, coach, scientist, and clinician.
1Institute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, GERMANY; 2Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UNITED KINGDOM; 3Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge, UNITED KINGDOM; and 4Center of Locomotor System, Sports Medicine and Prevention, Hospital Center of Luxemburg, LUXEMBURG
Address for correspondence: Jürgen Scharhag, M.D., Institute of Sports and Preventive Medicine, University of Saarland, Campus Building B8.2, 66123 Saarbrücken, Germany; E-mail: firstname.lastname@example.org.
Submitted for publication December 2007.
Accepted for publication March 2008.